American family physician
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American family physician · Aug 2003
ReviewWest Nile virus in the United States: an update on an emerging infectious disease.
West Nile virus is a mosquito-borne flavivirus and human neuropathogen. Since the virus was recognized in New York City in 1999, it has spread rapidly across the United States, with human disease documented in 39 states and the District of Columbia. West Nile virus can cause a broad range of clinical syndromes, including fever, meningitis, encephalitis, and a flaccid paralysis characteristic of a poliomyelitis-like syndrome. ⋯ Local or state health departments usually can perform the test within 24 to 36 hours of submission. Treatment is supportive. Prevention relies on comprehensive mosquito-control programs and measures to avoid mosquito bites, including the use of mosquito repellents containing N,N-diethyl-m-toluamide.
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Status epilepticus is an increasingly recognized public health problem in the United States. Status epilepticus is associated with a high mortality rate that is largely contingent on the duration of the condition before initial treatment, the etiology of the condition, and the age of the patient. Treatment is evolving as new medications become available. ⋯ Moreover, investigators have reported that status epilepticus often is not considered in patients with altered consciousness in the intensive care setting. In patients with persistent alteration of consciousness for which there is no clear etiology, physicians should be more quickly prepared to obtain electroencephalography to identify status epilepticus. Physicians should rely on a standardized protocol for management of status epilepticus to improve care for this neurologic emergency.
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Selective serotonin reuptake inhibitors (SSRIs) are widely used because of their safety, tolerability, and demonstrated efficacy across a broad range of clinical conditions. Medical literature supports the use of SSRIs for the treatment of many conditions outside of the indications approved by the U. S. ⋯ When taken in combination with tricyclic antidepressants, SSRis offer more potent therapy for fibromyalgia than either agent alone. SSRIs appear to be effective in some patients with neurocardiogenic syncope that is refractory to standard therapies. Clinical experience supported by ongoing research continues to expand on the broad array of therapeutic applications for this class of medication.
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Rotational and angular problems are two types of lower extremity abnormalities common in children. Rotational problems include intoeing and out-toeing. Intoeing is caused by one of three types of deformity: metatarsus adductus, internal tibial torsion, and increased femoral anteversion. ⋯ Treatment is usually conservative. Special shoes, cast, or braces are rarely beneficial and have no proven efficacy. Surgery is reserved for older children with deformity from three to four standard deviations from the normal.